Randomised trial of effect of amiodarone on mortality in patients with left-ventricular dysfunction after recent myocardial infarction: EMIAT Julian, D.G.; Camm, A.J.; Frangin, G.; Janse, M.J.; Munoz, A.; Schwartz, P.J.; Simon, P. General rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: http://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. Download date: 22 Mar 2019Randomised trial of effect of amiodarone on mortality in patients with left-ventricular dysfunction after recent myocardial infarction: EMIAT D G Julian, A J Camm, G Frangin, M J Janse, A Munoz, P J Schwartz, P Simon, for the European Myocardial Infarct Amiodarone Trial Investigators* THE LANCET SummaryBackground Ventricular arrhythmias are a major cause of death after myocardial infarction, especially in patients w it h poor left -vent ric ular func t ion. P revious at t empt s t o ident ify and suppress arrhy t hmias w it h v arious antiarrhythmic drugs failed to reduce or actually increase mortality. Amiodarone is a powerful antiarrhythmic drug with several potentially beneficial actions, and has shown benefit in several small-scale studies. We postulated that this drug might reduce mortality in patients at high risk of death after myocardial infarction because of impaired vent ric ular func t ion, irrespective of w hether they had ventricular arrhythmias.

Measurement of HRV in a large set of centrally processed Holter recordings is feasible with robust methods of assessment. Patients with LVEF < or =40% and depressed HRV benefit from prophylactic antiarrhythmic treatment with amiodarone. However, this finding needs confirmation in an independent data set before clinical practice is changed.

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the EMIAT and CAMIAT InvestigatorsBackground-Investigations with in vitro and animal models suggest an interaction between amiodarone and ␤-blockers.The objective of this work was to explore if an interaction with ␤-blocker treatment plays a role in the decrease of cardiac arrhythmic deaths with amiodarone in patients recovered from an acute myocardial infarction. Methods and Results-A pooled database from 2 similar randomized clinical trials, the European Amiodarone Myocardial Infarction Trial (EMIAT) and the Canadian Amiodarone Myocardial Infarction Trial (CAMIAT), was used. Four groups of post-myocardial infarction patients were defined: ␤-blockers and amiodarone used, ␤-blockers used alone, amiodarone used alone, and neither used. All analyses were done on an intention-to-treat basis. Unadjusted and adjusted relative risks for all-cause mortality, cardiac death, arrhythmic cardiac death, nonarrhythmic cardiac death, arrhythmic death, or resuscitated cardiac arrest were lower for patients receiving ␤-blockers and amiodarone than for those without ␤-blockers, with or without amiodarone. The interaction was statistically significant for cardiac death and arrhythmic death or resuscitated cardiac arrest (Pϭ0.05 and 0.03, respectively). Findings were consistent across subgroups. Conclusions-These findings are based on a post hoc analysis. However, they confirm prior results from in vitro and animal experiments suggesting an interaction between ␤-blockers and amiodarone. In practice, not only is the adjunct of amiodarone to ␤-blockers not hazardous, but ␤-blocker therapy should be continued if possible in patients in whom amiodarone is indicated. (Circulation. 1999;99:2268-2275.)